Brief Article
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World J Anesthesiol. Mar 27, 2014; 3(1): 124-128
Published online Mar 27, 2014. doi: 10.5313/wja.v3.i1.124
Predictive value of extravascular lung water indexed to predicted body weight
Fu-Tsai Chung, Shu-Min Lin, Horng-Chyuan Lin, Chih-Teng Yu, Meng-Heng Hsieh, Yueh-Fu Fang, Chien-Yin Liu, Chih-Hsi Kuo, Tsai-Yu Wang
Fu-Tsai Chung, Shu-Min Lin, Horng-Chyuan Lin, Chih-Teng Yu, Meng-Heng Hsieh, Yueh-Fu Fang, Chien-Yin Liu, Chih-Hsi Kuo, Tsai-Yu Wang, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taipei 333, Taiwan
Fu-Tsai Chung, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 259, Taiwan
Author contributions: All the authors contributed equally to this manuscript.
Supported by Grants from Taiwan National Science Council, No. NSC- 100-2314-B-182A-054; and Chang Gung Memorial Hospital, Nos. CMRPG3B0831, CMRPG3B0832 and CMRPG3A0562
Correspondence to: Fu-Tsai Chung, MD, Department of Thoracic Medicine, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, 199 Tun Hwa N Rd, Taipei 333, Taiwan. vikingchung@yahoo.com.tw
Telephone: +886-3-3281200-8467 Fax: +886-3-3272474
Received: June 15, 2013
Revised: September 4, 2013
Accepted: January 6, 2014
Published online: March 27, 2014
Processing time: 270 Days and 13.6 Hours
Abstract

AIM: To investigate extravascular lung water indexed to predicted body weight (EVLWIp) and actual body weight (EVLWIa) on outcome of patients with severe sepsis.

METHODS: Transpulmonary thermodilution was prospectively used to measure cardiovascular hemodynamics, EVLWIp and EVLWIa via an arterial catheter placed in each patient within 48 h of meeting the criteria for severe sepsis from a medical intensive care unit (ICU) at a university affiliated hospital. Survival was the single dependent variable. In order to examine and compare the predictive power of EVLWIp, EVLWIa and other clinically significant factors in predicting the in-hospital survival status of severe sepsis patients in the medical ICU, a receiver operating characteristic (ROC) curve method to analyze the significant variables and the area under the ROC curve (AUC) of the variables, P value and 95%CI were calculated.

RESULTS: In total, 33 patients were studied. In the ROC curve method analyses, EVLWIp (the AUC: 0.849; P = 0.001, 95%CI: 0.72-0.98) was as predictive for in-hospital survival rate as variables with EVLWIa (AUC, 0.829; P = 0.001, 95%CI: 0.68-0.98). The proportion of patients surviving with a low EVLW (EVLWI < 10 mL/kg) was better than that of patients with a higher EVLW, whether indexed by actual (HR = 0.2; P = 0.0002, 95%CI: 0.06-0.42) or predicted body weight (HR = 0.13; P < 0.0001, 95%CI: 0.05-0.35) during their hospital stay with the Kaplan-Meier method (76% vs 12.5%, respectively).

CONCLUSION: This investigation proposed that EVLWIp is as good a predictor as EVLWIa to predict in-hospital survival rate among severe sepsis patients in the medical ICU.

Keywords: Extravascular lung water index; Predicted body weight; Actual body weight; In-hospital survival; Severe sepsis

Core tip: Our study provides the important finding that extravascular lung water index (EVLWI) indexed by predicted body weight is as good as it indexed by actual body weight for for in-hospital survival in patients with severe sepsis. Clinicians could monitor EVLWI indexed by predicted or actual body weight in patients with severe sepsis.